Gastroesophageal reflux disease (GERD) is a common problem in medical practice. Estimates are that 10% of the U.S. population will experience daily heartburn and up to 40% will have symptomatic GERD on a frequent basis. Current medical therapy allows physicians to provide complete symptom relief, maintain long-term symptom remission and prevent complications. New advances in minimally invasive surgical techniques have made antireflux surgery an attractive alternate for long-term management in selected patients. This article reviews current medical treatment and indications for surgical referral in GERD.